GSBS Dissertations and Theses

ORCID ID

0000-0003-2870-4133

Publication Date

2018-06-18

Document Type

Doctoral Dissertation

Academic Program

Clinical and Population Health Research

Department

Quantitative Health Sciences

First Thesis Advisor

Catarina Kiefe

Second Thesis Advisor

Robert Goldberg

Keywords

Ventricular tachycardia, ventricular fibrillation, ventricular arrhythmia, incidence, mortality, fatality, rate, trend, depression, anxiety, acute myocardial infarction, acute coronary syndrome, hyperglycemia, glucose

Abstract

Introduction: Ventricular arrhythmias (VAs) are common after an acute coronary syndrome (ACS) and are associated with worse clinical outcomes. However, little is known about recent trends in their occurrence, their association with serum glucose levels, and their psychological impact in ACS setting.

Methods: We examined 25-year (1986-2011) trends in the incidence rates (IRs) and hospital case-fatality rates (CFRs) of VAs, and the association between serum glucose levels and VAs in patients with an acute myocardial infarction (AMI) in the Worcester Heart Attack Study. Lastly, we examined the relationship between in-hospital occurrence of VAs and 12-month progression of depression and anxiety among hospital survivors of an ACS in the longitudinal TRACE-CORE study.

Results: We found the IRs declined for several major VAs between 1986 and 2011while the hospital CFRs declined in both patients with and without VAs over this period. Elevated serum glucose levels at hospital admission were associated with a higher risk of developing in-hospital VAs. Occurrence of VAs, however, was not associated with worsening progression of symptoms of depression and/or anxiety over a 12-month follow-up period in patients discharged after an ACS.

Conclusions: The burden and impact of VAs in patients with an AMI has declined over time. Elevated serum glucose levels at hospital admission may serve as a predictor for in-hospital occurrence of serious cardiac arrhythmias. In-hospital occurrence of VAs may not be associated with worsening progression of symptoms of depression and anxiety in patients with an ACS.

DOI

10.13028/M2NH53

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Available for download on Saturday, June 20, 2020

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